1. THE EMBRYOLOGICAL REMNANTS

2. PERSISTANT REMNANTS OF BRANCHIAL APPARATUS & THYROGLOSSAL DUCT
First branchial arch fistula – cervico aural
Second branchial arch fistula
Third and fourth branchial arch abnormalities
Disorders of thyroglossal duct

4. DESTINATION
A MIDLINE LUMP’S EN-ROUTE

5. A MIDLINE LUMP’S DISCRETE FORTUNE
DR. AJAY MANICKAM
JUNIOR RESIDENT
DEPARTMENT OF OTOLARYNGOLOGY
RG KAR MEDICAL COLLEGE

7. CASE HISTORY
With C/O
Swelling in the front of neck for the past 14 yrs
Foreign body sensation in throat for the past 1 month

8. NO HISTORY

11. Examination in opd The mass in the neck was around 5 x 4 cm
It was mobile, non tender, insidious in onset and gradually progressive
Moves with deglutition
Moves with protrusion of tongue

13. EXAMINATION OF ORAL CAVITY

14. INDIRECT LARYNGOSCOPY EXAMINATION
Mass in the supraglottis, extending to vallecula, glottic chink was narrow, bilateral arytenoids, AE folds, Vocal folds were mobile
NO PALPABLE NECK NODES

15. DIAGNOSTIC DILEMMA 1. Laryngeal carcinoma 2. Sebaceous cyst
3. Dermoid cyst
4. Lipoma
5. Branchial Cleft cyst
6. Metastatic Lymphnode
7. Ectopic thyroid

16. CLINCAL EXAMINATION CLASSICAL APPEARANNCE MOVEMENT POSITION
HISTORY NEARLY 14 YEARS
AGE
H/O SMOKING, ALCOHOLISM

17. PLAN
ADMISSION
INVESTIGATION

18. INVESTIGATIONS ULTRA SONOGRPHY OF NECK
Solid SOL with echogenic matter, measuring 4x3cm, anterior and superior to the thyroid gland
FNAC
Thyroglossal cyst

19. CT SCAN OF NECK Heterogeneously enhancing necrotic,mass lesion with
Superior extent to the left supraglottic region upto valeculla
Lateral
extension into
left paraglottic
Space
Anteriorly it extended within the subcutaneous tissue with erosion of left thyroid lamina

20. MANAGEMENT

21. MANAGEMENT
Sistrunk operation

22. TRACHEOSTOMY

23. Post operative management

24. DAY 0 –DAY 7

25. HISTOPATHOLOGICAL REPORT

26. THYROGLOSSAL CYST

27. DISCUSSION INFRA HYOID SUPRA HYOID INTRA LINGUAL SUPRA STERNAL
Laryngeal extension

28. THYROGLOSSAL CYST
ENROUTE LARYNX

29. Clinical examination
Radiological guidance in cases with diagnostic dilemma
Intra laryngeal extension though rare to be kept in mind

30. THANK YOU